We carried out an unannounced comprehensive inspection of Willow Court Care Home on 9 and 10 January 2018. At the last comprehensive inspection of the service on 21 and 22 November 2016 breaches of legal requirements were found in relation to the safety of medicine management and the governance of the service. Due to this a focused inspection was carried out on 13 June 2017 to check that the service was meeting legal requirements. At this inspection the service had made the required improvements. We found these improvements had continued and the service was meeting the legal requirements.

Following the last comprehensive inspection, we asked the service to complete an action plan detailing what they would do and by when to improve the key questions of safe, effective and well-led to at least good. We saw infection control measures were now in place and medicines were being managed safely. Staff training and induction processes were very robust and regular supervisions were being held with all staff. The mealtime experience had been improved but this was not consistent within each dining room. The governance of the service had improved and we saw evidence of regular audits and actions taken if any issues were highlighted.

Willow Court Care Home is a ‘care home’ located in North Shields. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Willow Court Care Home can accommodate 48 people in one adapted building and on the date of this inspection there were 40 people living at the home.

There was a registered manager in post who has been employed at the service since September 2014 and was registered with the Care Quality Commission (CQC) to provide regulated activities in June 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us that they felt safe at the home and relatives agreed with these comments. We found there were policies and procedures in place to help keep people safe. Staff had received training and attended supervision sessions around safeguarding vulnerable adults.

Staff were safely recruited and they were provided with all the necessary induction training required for their role. The registered manager continued to provide on-going training for staff and monitored when refresher training was required. Accidents and incidents were recorded correctly and if any actions were required, they were acted upon and documented.

The premises were safe. Regular checks of the premises, equipment and utilities were carried out and documented. Infection control measures were in place and the service was clean. We saw domestic staff cleaning the home regularly during the inspection.

We saw positive and negative dining experiences. During lunchtime on the first day of inspection we observed that there was not enough staff present to support people in the ground floor dining room. People living at the service commented that they had to wait for staff to help them. We saw that there were sufficient staffing levels at Willow Court but the deployment of staff was an issue. People told us that staff were busy and did not help them when they needed it. We observed people asking for staff to support them to the toilet but having to wait to be assisted. We fed this information back to the registered manager who addressed it immediately.

The service had continued to provide safe medicine management. Procedures were in place to ensure the safe receipt, storage, administration and disposal of medicines. We saw a dentist visiting people and there were records re

We carried out an unannounced comprehensive inspection of this service on 21 and 22 November 2016. Breaches of legal requirements were found in relation to the safety of medicine management and governance of the service. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements.

We undertook this focused inspection on 13 June 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Willow Court’ on our website at www.cqc.org.uk

Willow Court is a residential care home situated in North Shields. It provides accommodation, personal and nursing care for up to 48 people with physical and mental health related conditions. At the time of our inspection 43 people lived at the service and one person was on a short break stay.

There was a registered manager in post who has been employed to manage the service since September 2014 and was registered with the Care Quality Commission (CQC) to provide regulated activities in June 2015. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service had a history of non-compliance dating back to 2014 which related to issues such as safeguarding, infection control, staff training and medicine management; however we found improvements had been made in all of these areas.

At our last inspection we found that medicines were managed inconsistently throughout the home and not always in line with company policy. At this inspection, we found that improvements had been made to ensure all staff followed the same working practices and that company policy was followed. We found up to date documentation was in place and it was completed to a good standard. This meant people’s medicines were safely managed.

At our last inspection there was a strong malodour throughout the corridors and in some communal areas. We made a recommendation about this. At this inspection, we found this had reduced as the registered manager and staff had taken appropriate action to address this issue.

At this inspection, people told us they felt safe living at the home and relatives echoed this. Staff had an awareness of safeguarding vulnerable adults and risk assessments were in place to minimise the likelihood of people coming to any harm.

Accident and incidents continued to be recorded and monitored by the registered manager. They had referred these as necessary to external agencies such as the local authority or the CQC.

The premises were safe. Routine checks of the premises and equipment were conducted by staff and recorded.

We heard mixed comments from people and relatives about staffing levels and we witnessed one example where staff were not present when needed. We identified that this was around the deployment of staff because there were sufficient staff on duty.

Staff continued to be safely recruited and they had been trained in topics relevant to their role. Staff now had their competency checked more often and refresher training was in place. New care staff had undertaken a robust induction process.

The provider had ensured that the design of the home was ‘dementia friendly’. Walls, floors and doors were pained in brightly contrasting colours and had appropriate pictorial signage. The décor in people’s bedrooms and communal areas was homely and objects of memorabilia were used to stimulate memories and conversation.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguar

This unannounced inspection took place on 21 November 2016 and we returned the following day to complete the inspection process.

Willow Court is a residential care home situated in North Shields. The home has two floors and all bedrooms have en-suite facilities. It provides accommodation, personal and nursing care for up to 48 people with physical and mental health related conditions. At the time of our inspection 42 people lived at the service.

There was a registered manager in post who has been employed to manage the service since September 2014 and was registered with the Care Quality Commission (CQC) to provide regulated activities in June 2015. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service has historical non-compliance which related to safeguarding, infection control, cleanliness and medicines management; however we found the provider was complying with these regulations when we last inspected the service on 28 May 2015. At the inspection in 2015 the service still required some improvement, particularly with regards to safety and responsiveness.

The registered manager carried out daily, weekly and monthly checks on the safety and quality of the service using an electronic audit system. This automatically presented information and gave oversight to the registered manager and the provider. Although these processes were in place, they were not always effective enough to identify the issues we raised during the inspection with regards to compliance with statutory regulations. After the inspection, we discussed this with the registered manager who told us action would be taken to address the shortfalls in the service.

There was a medicines policy and associated procedures in place; however medicines were managed inconsistently throughout the home and not always in line with company policy. We found issues with the storage, administration, stock control and recording of medicines which meant medicines were not managed safely.

People we spoke with told us they felt safe living at Willow Court. Relatives confirmed this. Staff had been trained with regards to safeguarding of vulnerable adults and demonstrated awareness of their responsibilities towards protecting people from harm. Policies, procedures and systems were in place to support staff with the delivery of the service. Individual risks which people faced in their daily lives had been assessed (with the exception of some risks associated with medicine administration) and control measures were in place to reduce the possibility of an incident or accident occurring.

Incidents and accidents were recorded electronically; there was evidence of an investigation by the registered manager and these were monitored by the provider. Action plans were implemented to reduce the likelihood of a repeat event. The registered manager had reported all incidents to external bodies as required and had written letters of apology to people and relatives if necessary.

Routine safety checks were carried out around the premises; we observed the handyman completing these checks during the inspection and a practice fire drill took place. We also found the provider had suitable emergency contingency plans in place should these be required to be activated by staff.

There was a strong malodour throughout the corridors and in some communal areas. We have made a recommendation about this. We found the design of the home had elements of best practice with regards to dementia care. Walls and floors contrasted and doors were brightly coloured with appropriate signage. The décor in people’s bedrooms and communal areas was homely and objects of memorabilia were used to stimulate memories and conversation.

People and re

In this report the names of two registered managers appear. One of the managers was not in post and not managing the regulatory activities at this location at the time of our inspection. His name appears because he was still a registered manager on our register and had not deregistered.

We were unable to speak to some of the people using the service because of the nature of nature of their condition.

We spoke with four people, three relatives and five care workers about the care and support provided by the service. One person told us, “I’m happy here. The best part about being here is that I am comfortable and I am well looked after.” Another person commented, “I find the girls very good really. They really care and they know what they are doing.” A relative told us, “The staff are well trained. Overall, we are very happy with service here.” Another relative said, “They have good staff here and the care and support is really good. X [staff members name] is a real gem; he has really good interactions with my dad.”

We found that staff received appropriate training, professional development, appraisal and supervision. One care worker told us, “We have regular staff meetings, supervisions and plenty of training. I feel supported by management.”

We spoke with three people and 10 relatives to find out their opinions of the care and treatment at the service. One relative told us, “I am always informed of any changes in my mother’s condition and treatment.”

We found people’s needs were assessed and care and treatment was planned and delivered in line with their individual care plans. Relatives we spoke with were positive about the care and support people received. One relative told us, “I find the place wonderful, the care here is fantastic.” Another relative said, “The carers are so caring."

We found that there were suitable numbers of skilled, qualified and experienced care staff. Relatives were complimentary about the staff. One person told us, “I have recommended the home to other friends; the nursing staff are all excellent.”

Staff informed us that they were appropriately trained; however we found that suitable appraisal and supervision arrangements were not fully in place.

We found that effective systems were in place to regularly assess and monitor the quality of service provided.

We saw that people’s personal records, staff records and other records relevant to the management of the home were accurate and fit for purpose.

In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

Thirty six people were living at Willow Court Care Home at the time of this inspection.

As we walked around the premises we spoke with some of them, although most people had complex needs which meant they were not able to tell us their experiences.

We viewed care records for six people. We found that care was planned and delivered in a way which met people’s individual needs.

We found that appropriate arrangements were in place for the management of medicines at the service and that care was provided in an environment which was suitably designed and adequately maintained.

Forty three people were living at Willow Court Care Home at the time of our visit.

As we walked around the premises we spoke with some of them, although most people had complex needs which meant they were not able to tell us their experiences.

We spoke with relatives of five people who were using the service. Their comments included, “It seems fine, she’s looked after”, “It’s absolutely brilliant care” and “The care staff are great, they are patient”.

People living at the home were unable to tell us what they thought about living at the home as they had dementia. There was evidence that people were helped to make choices. They were observed to be well cared for and staff were polite and kind when talking and working with them.

This inspection took place on 28 May and 16 June 2015 with the first day of the inspection unannounced. We were required to delay the second day of the inspection, as was the home was dealing with a viral outbreak and was appropriately restricting non-essential visits to the premises to contain any spread of infection.

At the last inspection carried out in July and August 2014 we found breaches of regulations relating to safeguarding, cleanliness and infection control and medicines management. This inspection was to check on action carried out at the home following that previous inspection, but also to review the overall rating of the quality of care provided at Willow Court. At this inspection we found no breaches of regulations but felt there were still elements of care that could be further developed.

The home had a registered manager who had been registered since June 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered provider had policies and procedures designed to protect people from harm or abuse. Staff were aware of the need to safeguard people from abuse. There told us they had received training in relation to this area and were able to describe the action they would take if they had any concerns. Staff were also aware of the registered provider’s whistleblowing policy and told us they would immediately raise any concerns they had about care.

The registered manager and handyman told us the premises were being redecorated and some refurbishment was taking place. We found the shower rooms and bathrooms were in need of attention and updating. On the first day of the inspection we found some areas of the home required cleaning, or there were odours in specific areas. On the second day of our inspection we saw the home was cleaner and noted work had started on bathrooms to bring them up to date and improve the overall cleanliness of the areas. Fire systems and other safety checks were carried out on a regular basis.

Most people told us there were enough staff at the home to meet people’s care needs. Suitable recruitment procedures and checks were in place to ensure staff had the right skills to support people at the home. We found medicines were appropriately managed, recorded and stored safely.

People told us they felt staff had the right skills to support them. Staff confirmed they had access to a range of training and opportunities to update their skills, and records confirmed this. Staff also told us they had regular supervision and they received annual appraisals.

People and their relatives said the meals provided at the home were good. We spent time observing lunches at the home and noted the food to be hot and appetizing. People who required assistance were supported with their meals in a dignified and appropriate way. Kitchen staff demonstrated knowledge of people’s individual dietary requirements and current guidance on nutrition. People likes and dislikes were not always recorded, although staff said they knew people well and were aware of their individual requirements.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. Staff understood the concept of acting in people’s best interests and the need to ensure people made decisions about their care. The registered manager confirmed applications had been made to the local authority safeguarding adults team to ensure appropriate authorisation and safeguards were in place for those people who met the threshold for DoLS, in line with the MCA.

People we spoke with and their relatives told us they were happy with the care provided. We observed staff treated people patiently and appropriately. Staff were able to demonstrate an understanding of people’s particular needs. People’s health and wellbeing was monitored, with ready access to general practitioners, dentists, opticians and other health professionals. Staff were able to explain how they maintained people’s dignity during the provision of personal care.

Care plans reflected people’s individual needs and were reviewed to reflect changes in people’s care. However, in some people’s care records it was not always possible to identify the most recent plans for care delivery. Some activities were offered for people to participate in. The home had two activities co-ordinators who told us about a range of activities they were delivering and developing. The registered manager told us that having a job share activities post gave a wider range of activities and the provision of a male member of staff in an activities role had helped men at the home participate more.

People and relatives told us they would speak to the registered manager if they wished to raise a complaint. We saw from records complaints had been dealt with appropriately and a response offered to the person who made the original complaint.

The registered manager undertook regular checks on people’s care and the environment of the home. Staff felt well supported and were positive about the registered manager’s impact on care at the home and the running of the service. There were meetings with staff and relatives of people who used the service, to allow them to comment on the running of the home.